Table 2.

Effect of non-surgical treatments for urinary incontinence on sexual function

Study	Study Design	N	Treatment	Treatment Length	Instrument	Findings
						Sexual Function	Coital Incontinence
Pelvic Floor Muscle Training (SUI)
Bo et al [48]	Randomized controlled trial	1. PMFT: 25	PMFT	6 months	B-FLUTS	• Non-significant improvement in pain, urinary-related sexual problems	• Improved
		2. Control: 30
Zahariou et al [49]	Prospective case series	Total: 58	PFMT	12 months	FSFI	• Improvement in FSFI and subscale scores (p < 0.05)	• Improved (p < 0.005)
Pelvic Floor Muscle Training (UUI)
Wang et al [50]	RCT	1. PFMT: 34	1. PFMT	12 weeks	KHQ: Personal Relationship Domain	• Non-significant improvement in Personal Relationship Domain in biofeedback-assisted PFMT group	N/A
		2. Biofeedback-assisted PFMT: 34	2. Biofeedback-assisted PFMT
		3. Transvaginal electrical stimulation: 35	3. Transvaginal electrical stimulation
Anti-incontinence Pessary (SUI)
Handa et al [52]	Randomized controlled trial	1. Continence pessary: 149	1. Continence pessary	12 months	SPEQ (3 domains), PISQ-12	Responders (vs. non-responders):	• Improved (p = 0.0002)
		2. Behavioral therapy: 146	2. PMFT			• PISQ improved (p = 0.007)	• Greater improvement
		3. Combo: 150	3. Combination			• Restriction of sex due to UI improved (p = 0.008)	• with combo therapy (p = 0.019) and behavioral (p = 0.02) vs. pessary alone
						• Dyspareunia improved (p = 0.017)
Transvaginal electrical stimulation (SUI and UUI)
Giuseppe et al [51]	Prospective case series	Total: 23	Transvaginal electrical stimulation	3 months	FSFI	Significant improvement in FSFI and all subscale scores (p ≤ 0.01) except arousal, orgasm	N/A
		SUI: 8
		UUI: 10
		MUI: 5
Anti-cholinergic medication (UUI)
Sand et al [53]	RCT	Total: 2878	1. Patient education & transdermal oxybutynin	12 weeks	KHQ: Personal Relationship Domain	Significant improvement in KHQ score, bladder pain, effect of OAB on sex life, interest in sex	Improved
		Female: 2508	2. Transdermal oxybutynin only
Rogers et al [54]	RCT	1. Placebo: 189	1. Placebo	12 weeks	PISQ	Significant improvement of PISQ and domain scores after 12 weeks	N/A
		2. Tolterodine: 188	2. Tolterodine 4 mg ER daily			Stable but no continued improvement if used 12 additional weeks except in Physical domain
Danilova et al [58]	Prospective case series	57	Trospium 15 mg three times daily	16 weeks	Unknown	Sexual dysfunction decreased	N/A
Chapple et al [56]	RCT	1. Placebo: 283	1. Placebo	12 weeks	KHQ: Personal Relationship Domain	Patients with OAB, total	N/A
		2. Fesoterodine 4/8 mg: 272	2. Fesoterodine 4 mg			Statistically significant improvement in fesoterodine 8 mg (vs. placebo) (mean score change of -11.9 v -6.2, p < 0.05)
		3. Tolterodine ER 4 mg: 290	3. Fesoterodine 8 mg			Patients with both UUI & OAB:
			4. Tolterodine ER 4 mg			Statistically significant improvement intolterodine (vs. placebo) (-12.7 v -6.8, p < 0.05)
Percutaneous tibial nerve stimulation (UUI)
Eftekhar et al [59]	RCT	1. Percutaneous tibial nerve stimulation and tolterodine 4 mg daily: 25	1. Percutaneous tibial nerve stimulation and tolterodine 4 mg daily	12 weeks	FSFI	Within each arm:	N/A
		2. Tolterodine 4 mg daily: 25	2. Tolterodine 4 mg daily			Significant improvement in FSFI and subscale scores after 12 weeks (p < 0.001)
						Between arms:
						No significant difference in FSFI, subscale scores
van Balken et al [60]	Prospective case series	Total: 121	Percutaneous tibial nerve stimulation	12 weeks	NSF-9	Significant improvement in Satisfaction (p < 0.005), Frequency (p < 0.005), Orgasm (p < 0.05)	N/A
		Female: 76				No significant change in dyspareunia, lubrication

B-FLUTS Bristol female lower urinary tract symptoms; FSFI Female sexual function index; PISQ-12 Short form pelvic organ prolapse-urinary incontinence sexual function questionnaire; PFMT Pelvic floor muscle training; RCT Randomized controlled trial; SA Sexual activity; SPEQ: Short form personal experience questionnaire